public health Archives - Prindle Institute

August 28, 2023

Caring, the Self, and Self-Care

painting of laborers at construction site

The concept of self-care, as of late, has gained a kind of cultural omnipresence. Originating in the context of healthcare, self-care was, at first, used to describe the ways in which patients with chronic illness might work to improve their physical health: a balanced diet, regular exercise, and the like. But having grown beyond this strictly clinical context, self-care is now something much more: for students and teachers; for parents and children; for business owners and employees; for HR professionals and for anti-capitalists. Self-care has even circled back on its origins: it is no longer just something for people who are receiving healthcare, but — in the light of a crisis of mental health among nurses, physicians, and medical students — also for those who provide it.

Self-care is, of course, something which is deeply important: there’s a reason, after all, that the medical community has emphasized self-care for over 50 years, and that well-meaning friends will advise you to care for yourself when they see that you aren’t. But for all of the self-care advice which you might encounter — to go on walks, to journal, to take a bubble bath, or read a book — ubiquity has not brought the concept of self-care clarity.

In my first week of medical school, we frequently encountered talk of self-care. In PowerPoint presentations, we were told to prioritize diet, exercise, and time with our families. We were told to remember to drink water; we were invited to guided yoga sessions and optional lectures on mindfulness. When a panel on physician wellness was held, we were told that what we were doing was hard, but that it got better: we just needed self-care — to meditate or keep a mental health journal — in the meantime.

In your own professional context, you’ve likely heard similar advice, whether it be from a teacher, professor, or boss. This advice, however, admits to a specific understanding of what it means to care: namely, one which is reactive. Self-care is most frequently emphasized in environments which are inherently stressful: our classrooms, where students face exams and social pressures, and our places of work, where failing to meet expectations can deeply impact both you and your loved ones. Much of the same can be said of medical school, where advice on self-care was a theme of the first week precisely because it would be required the week after. Across these contexts, self-care is a kind of coping strategy: a way to deal with the hardships which we will encounter in our day-to-day lives.

This picture of what it means to care for oneself, however, is simply incomplete. While self-care is an important tool for dealing with stress, human flourishing involves more than just coping. Really caring for someone — including yourself — means not just being reactive, but also proactive: it means not just finding strategies for dealing with stressors, but also seeking to thrive. Self-care advice, however, is primarily oriented towards the former rather than latter: we use self-care as a way to cope, and much less often as a way to flourish.

A large part of this likely comes from the emphasis on self-care in educational and professional contexts. Self-care, in these spaces, is a means to an end: even if you’re fortunate enough to have a teacher or boss which truly cares about your thriving, self-care is emphasized insofar as it facilitates productivity. This is why appeals to self-care can strike a student or employee as shallow, or even unserious: in many classrooms and workplaces, self-care isn’t really for you, but for the sake of the organization. And, further, students and employees know what would likely happen if their self-care was oriented more towards their thriving rather than their productivity: self-care cannot interfere with attendance or the satisfaction of expectations. Here, we can see how reactive self-care benefits our institutions, while proactive self-care, sometimes, does not.

I don’t blame us for our focus on reactive self-care. Many don’t even have the privilege to think reactively about self-care, let alone proactively. But this raises an important point. Self-care is, obviously, something which you do — self-care places the burden of both reactive and proactive care solely on your shoulders. Human flourishing, though, is rarely something which can be understood in such solitary terms. Self-care emphasizes the self, and fails to acknowledge the fact that your well-being is, in large part, context-dependent: the expectations placed on you at work and school, and the stressors you encounter there, will affect your well-being. A single-minded focus on self-care, then, can separate cause from effect, and direct our attention towards stabilizing our well-being rather than the reasons our well-being is poor: it is an incredibly effective tool for shifting the entire responsibility for one’s poor well-being entirely onto the individual, rather than the environment (the school, workplace, or society) which most likely bears some of the blame. Your school may emphasize self-care in the classroom, but ignore the bullying which makes you need self-care in the first place. Your workplace may offer classes on meditation, but if your self-care conflicts with your productivity, your boss will likely find someone who prioritizes the latter. If self-care is to truly be a form of care, then, it cannot rely entirely on the self, nor can it abstract the self from its context — and the fact that, at some level, our institutions have an obligation to care for us as well.

If we take these observations seriously, our acts of self-care will point towards us in a radically different direction. Self-care is not about struggling to keep one’s head above water: self-care is about the pursuit of thriving, and the transformation of our institutions in a way which fosters that thriving. It also challenges us to think about our obligations to others: the ways in which we burden others with their own care, rather than lifting that burden ourselves. Human thriving is complex and communal, and relies on more than bubble baths and journaling; but if we seek ways to truly care for ourselves and others, we work towards something which is much more meaningful.

September 26, 2022December 14, 2022

Is It Wrong to Say the Pandemic Is Over?

President Biden’s recent statement that the pandemic is “over” sparked a flurry of debate as many experts arguing that such remarks are premature and unhelpful. Biden’s own officials have attempted to walk back the remarks, with Anthony Fauci suggesting that Biden simply meant that the country is in a better place now compared to when pandemic first began. Some have even suggested that Biden is simply wrong in his assertion. But was it really wrong to say that the pandemic is over? Does the existence of a pandemic depend on what experts might say? Who should get to say if a pandemic is over? Are there moral risks to either declaring victory too soon or admitting achievements too late?

Following Biden’s statement many of his own COVID advisors seemed surprised. A spokesperson for the Department of Health and Human Services reiterated that the public health emergency remains in effect and that there would be a 60 day notice before ending it. Fauci suggested that Biden meant that the worst stage of the pandemic is over, but noted, “We are not where we need to be if we are going to quote ‘live with the virus’ because we know we are not going to eradicate it.” He also added, “Four hundred deaths per day is not an acceptable number as far as I’m concerned.” Biden’s Press Secretary Karine Jean-Pierre has conceded that the pandemic isn’t “over,” but that “it is now more manageable” with case numbers down dramatically from when Biden came to office.

The World Health Organization also weighed in on Biden’s assertion with WHO Director-General Tedros Adhanom Ghebreyesus stating that the end “is still a long way off…We all need hope that we can—and we will—get to the end of the tunnel and put the pandemic behind us. But we’re not there yet.” When asked whether there are criteria in place for the WHO to revoke the declaration of a public health emergency, WHO representative Maria Van Kerkhove said that it “is under active discussion.”

With nearly 400 deaths in America per day from COVID, and over one million dead in the U.S alone, many have been critical of the president’s remarks.

2 million new COVID infections were confirmed last month and there is still a concern among many about the effects of long COVID with persistent and debilitating symptoms for months after infection. Some estimates suggest that as many as 10 million Americans may suffer from this condition. The virus has also become more infectious as mutations produce new variants, and there is a concern that the situation could become worse.

Critics also suggest that saying that the pandemic is over sends the wrong message. As Dr. Emily Langdon of the University of Chicago noted, “The problem with Biden’s message is that it doubles down on this idea that we don’t need to worry about COVID anymore.” Saying that the pandemic is over will discourage people from getting vaccinated or getting boosters while less that 70% of Americans are fully vaccinated. Declaring the pandemic over also means an end to the emergency funds provided during the pandemic, perhaps even including the forgiveness of student debt.

On the other hand, there are those who defend the president’s assertion. Dr. Ashwin Vasan notes that “We are not longer in the emergency phase of the pandemic…we haven’t yet defined what endemicity looks like.”

This is an important point because there is no single simple answer to what a pandemic even is.

Classically a pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people.” However, this definition does not mention severity or population immunity. In fact, the definition of “pandemic” has been modified several times after the last few decades and currently the WHO doesn’t even use the concept as an official category. Most definitions are aimed at defining when the problem begins and not where it ends.

This reminds us that while there is an epidemiological definition of “pandemic,” the concept is not purely a scientific term. To the extent that public policy is shaped by pandemic concerns, then a pandemic is also a political concept. The declaration that the pandemic is “over” is, therefore, not purely a matter for experts. As I have discussed previously, there needs to be democratic input in areas of science where expert advice affects public policy precisely because there are also many issues involved that require judgments about values.

Some might suggest that the decision should be entirely up to scientists. As Bruce Y. Lee of Forbes writes, “there was the President of the U.S., who’s not a scientist or medical expert, at the Detroit Auto Show, which is not a medical setting, making a statement about something that should have been left for real science and real scientists to decide.” But this is simply wrong.

Yes, people don’t get a say about what the case numbers are, but to whatever extent there is a “pandemic” recognized by governments with specific government policies to address these concerns, then people should get a say. It is not a matter for scientist to decide on their own.

Many experts have suggested the saying the pandemic is over will lead people to think we don’t need to care about COVID anymore. David Dosner from Columbia University’s Mailman School of Public Health has expressed the concern that Biden’s comments will give a “kind of social legitimacy to the idea of going into crowds, and it just makes some people feel awkward not not doing that.” But ironically, the same experts who profess the need to follow the science, seem to have no problem speculating without evidence. How does anyone know that Biden’s statements would discourage people from getting vaccinated? Is anyone really suggesting that after all this time, the remaining 30% of the country that isn’t vaccinated is suddenly going to drop their plans to get vaccinated because of what Joe Biden said?

There is no good reason why saying the pandemic over would mean giving up our efforts to fight COVID. As noted, the term has no official use. The emergency declarations by the WHO and Department of Health would carry on regardless. On the other hand, despite the case rates, people around the world are returning to their lives. Even Canada recently announced the end to border vaccine mandates. While Fauci may not be comfortable with 400 deaths per day, maybe the American people are. As governments and the public lose interest in treating the pandemic as a “pandemic,” scientists risk straining their own credibility by focusing on what is important to them rather than gauging what the public is prepared to entertain policy-wise.

In an age of polarization and climate change, scientists need to be conscious about public reactions to their warnings. There is a risk that if the public construes the experts’ insistence on the pandemic mindset – despite the worst-case scenarios seeming to be increasingly remote – as ridiculous, then they will be less likely to find such voices credible in the future. When the next crisis comes along, the experts may very well be ignored. Yes, there are moral risks to declaring the pandemic over prematurely, but there are also very real moral risks to continuing to insist that it isn’t.

June 13, 2022October 25, 2023

Mental Health and the Uvalde Massacre

close-up photograph of multi-colored brush strokes on canvas

In the wake of the 21 deaths at the school shooting in Uvalde, Texas, the national conversation has once again turned to gun violence. And once again, political figures have saturated the airwaves with an abundance of explanations and solutions. The most prominent, of course, is gun control. However, figures like Texas Governor Greg Abbott and Uvalde Mayor Don McLaughlin have appealed to a different explanation – mental health.

There is reason to doubt Governor Abbott’s sincerity, and he was quickly taken to task for cuts in mental health resources and the deplorable state of the Texas mental health system. Politically, mental health is convenient as it provides a possible solution to problems of gun violence without getting into questions of gun control and gun rights.

However, even if mental health is being deployed as a cynical talking point in this particular context, that doesn’t mean it should not be part of a larger conversation about gun violence.

The causes of events like the Uvalde elementary school shooting are complex, and we can ask how the availability of lethal weaponry intersects with issues of poverty, inequality, racism, gun culture, and yes, mental health, to ultimately lead to violence.

However, folding mental health into the discussion is not without risks. First, it can stigmatize mental illness as something generally connected to violence, and second, it can lead to a very individualistic explanation of gun violence that fails to consider broader social and economic factors.

So, how should we understand the purported link between gun violence and mental health? The Uvalde gunman, Salvador Ramos, did not have a diagnosed mental health condition. Most mass shooters appear not to be classically psychotic – only 8% of mass shooters found to be psychotic in a recent study (although it varies somewhat by study). Although many mass shooters, perhaps unsurprisingly, have a record of being psychologically troubled in some way. The Violence Project, a study of mass shooting not affiliated with criminal activity, found generally high levels of suicidality and paranoia. Studies done by the U.S. Secret Service have found around half of mass shooters experienced mental health symptoms prior to attack.

The problem however is that mental health troubles are very common, and that mass shootings are very rare – even in the United States.

Moreover, while mental illness does have some correlation with violence,

the fact remains that the vast majority of people with diagnosed mental illness are not dangerous and violence may often be better explained by associated factors like unemployment or substance abuse.

Focusing on specific diagnosable mental illnesses then does not seem a productive way to address gun violence. The framing Governor Abbott used suggests that anyone who would commit this kind of violence must, necessarily, have a mental health problem. Philosophers and sociologists refer to the process by which something comes to be treated in a framework of health and disease as medicalization, and that is similar to what is happening here – engaging in a mass shooting is being treated as a sign of a medical problem.

However, whether or not something should be treated as a medical problem can be ethically contentious. First because it can subject people to forms of social control, e.g., involuntary hospitalization, and second because it prioritizes a medical explanation, e.g., Ramos’s actions are thought to betray an undiagnosed mental illness. This purportedly medical explanation can then prevent people from considering others causes, such as the availability of guns or the effect of racist ideology like replacement theory.

Medicalization is always a partly social process, but it is responsive to physical and behavioral features. Treating breast cancer or strep throat within the context of our medical system is an easy decision – they have well-known biological causes and are responsive to medical treatment like chemotherapy or antibiotics. There is, however, no parallel response for the tendency to commit mass shootings. We do not know how to diagnose it (prior to the shooting) or how to treat it. Consequently, even a general mental illness framing for mass shooting largely serves as a way to denigrate the behavior as pathological or abnormal, without providing much guidance about what can be done.

Potentially more promising for addressing gun violence are general welfare approaches to health including mental health. The World Health Organization famously defines health as not merely the absence of disease but “a state of complete mental, physical, and social well-being.“ Admittedly, by having such a broad understanding of health, this perspective tends to turn every problem into a health problem.

But it also helps to connect individual problems to societal problems, and individual well-being to societal well-being, making clear the scope of meaningful mental health solutions to gun violence.

This approach would seek the general social and economic conditions such that mass shootings are rare and could include big-ticket items like inequality.

Generally, mental health becomes less of a topic as one leaves the domain of mass shootings and enters the broader world of gun violence. However, there is one more obvious overlap – suicidality. Guns are an incredibly effective means of suicide and they make suicide attempts extremely fatal. As many people who attempt suicide do not then go on to attempt suicide again, the means matter. National attention to mental health could then be a key way to head off the suicide risk caused by high levels of gun ownership.

Governor Abbott’s remarks may be suspect, but the inclusion of mental health in our national conversation about gun control and gun violence is not.

March 28, 2022December 14, 2022

Why the Sunshine Protection Act Is Daylight Robbery

photograph of Los Angeles skyline at dawn

Earlier this month, the U.S. Senate unanimously voted in favor of the Sunshine Protection Act – a bill that would make Daylight Saving Time the new, permanent standard time from November 2023 onwards. Many may rejoice at this news. The process of adjusting our clocks twice a year can be enormously irritating. And it’s also dangerous. This biannual disruption to our circadian rhythms (the natural biological processes that follow a 24-hour cycle) has been linked to all kinds of negative side effects, including workplace injuries, sleep disturbances, stroke, and heart attacks. This includes a 6% increase in fatal traffic accidents — accounting for about 28 deaths per year.

While often blamed on farmers, daylight saving time was actually first introduced in the U.S. during World War I as an energy saving measure. Farmers, it turns out are vehemently opposed to the practice — which creates a huge interference with their standard routines. Given all of this, it might seem obvious why the Sunshine Protection Act received unanimous support in the Senate. But it turns out that there’s more to this issue than meets the eye.

For one, it isn’t simply a case of scrapping the biannual time transition. Most people are in favor of this — which might explain why the bill has received such widespread support. The more important part of this process is deciding which time we will permanently transition to. And here, we have two options. First, there is Standard or ‘Solar’ Time — that is, the time the U.S. currently uses from November through March. This time is based on the movement of the sun, and pins midday to the moment at which the sun is at its highest point in the sky (hence the term “high noon”). The alternative is Daylight Saving Time (DST) — that is, the time currently used from March through to November. This time sees our clocks offset from solar time by one hour, so that the sun is instead at its highest point at one o’clock in the afternoon.

It might seem like an arbitrary choice — and you might think that so long as we get rid of that meddlesome biannual adjustment, nothing else really matters. But this couldn’t be further from the truth.

It turns out that DST harms us in numerous ways. For one, it’s a public health risk. We sleep less long and less well, with Americans losing an average of 19 minutes sleep per night during DST. This may not sound like much, but this society-wide DST-induced sleep-loss has been connected to significant increases in the risk of heart disease, stroke, diabetes, cancer, high blood pressure, obesity, metabolic disorders, personality disorders, unintentional midday sleep, caffeine abuse, alcohol abuse, depression, and suicidality. That’s probably why we see things like a 24% uptick in heart attacks immediately after we change to DST each year. And this isn’t merely a result of the time transition, since the move back to Solar Time in November sees a corresponding reduction in heart attacks by around 10-21%.

DST is also bad for business. Workplace injuries among laborers typically increase 5.7% under DST, and result in 67.6% more days of lost work. Office productivity plummets by 20% for an average annual loss of $434 million nationwide. Perhaps worst of all, permanent DST would see most of us start school and work before sunrise for around a third of the year.

Unfortunately, the sole motivation behind the initial move to daylight saving — that is, the conservation of energy — no longer applies. This is largely down to the ways our lives have changed since World War I. DST now causes us to use more power — mostly in the form of morning heat and evening air conditioning. This subsequently leads to an increase in home energy costs, pollution, and climate change.

What’s interesting is that the U.S. already trialed the implementation of permanent DST back in 1974. Initially, 79% of the population were in favor of the change (no doubt fueled by relief that they would no longer have to adjust their clocks twice a year). But this support dropped to only 42% after just one winter — a winter in which eight children lost their lives walking to school on dark winter mornings in the space of just one month in Florida. The experiment ended shortly thereafter.

Given all of this, it’s deeply concerning that, while eradicating the biannual time transition, the Sunlight Protection Act is attempting to implement DST — not Solar Time — as the new standard time. But when we dig a little deeper, the choice isn’t all that surprising. There’s a lot of money to be made in DST. As previously noted, DST sees power and fuel consumption skyrocket — lining the pockets of the companies who provide those amenities. The National Association of Convenience Stores has also made no secret of their opinion on the matter, arguing before a Congress subcommittee that DST is “is good for business and commerce across the United States.” Other huge benefactors from a permanent transition to DST will be golf courses, with the National Golf Foundation admitting that the extra evening light will allow course operators to “accommodate more golfers/greens fee revenue.”

Ultimately, what might seem like an innocuous issue — whether to set our clocks according to the sun — is actually a matter of tremendous moral importance. While the shift to permanent DST might financially benefit certain businesses, it will come at a huge cost to society and the economy at large — robbing ordinary citizens of sleep, health, and money. Eradicating the biannual time transition in favor of permanent Solar Time would instead provide the best outcomes for the well-being of U.S. citizens — even if it means buying a few less slushies and rounds of golf.

January 4, 2021December 14, 2022

The Bigger Problem with “COVID Conga Lines”

photograph of full subway car with half of the passengers unmasked

On December 9th, days before New York would again order the re-closing of bars and restaurants in an attempt to stem the resurgence of COVID-19 cases seemingly spread by holiday travelers, dozens of members of New York’s Whitestone Republican Club gathered together for a holiday party at a restaurant in Queens; weeks later, multiple attendees have tested positive for the coronavirus and at least one partygoer has been hospitalized. Although restaurants were allowed to open at 25% capacity on the day of the party, restaurant visitors were also required to wear face masks while not eating; videos of the event — including one showing a prominent local candidate for city council happily leading a conga line — revealed that the majority of people in attendance neglected many of the public health guidelines designed to mitigate the spread of COVID-19.

In response to media coverage of its party, the Club released a statement that read, in part, “We abided by all precautions. But we are not the mask police, nor are we the social distancing police. Adults have the absolute right to make their own decisions, and clearly many chose to interact like normal humans and not paranoid zombies in hazmat suits. This is for some reason controversial to the people who believe it’s their job to tell us all what to do.”

Evoking something like “liberty” to defend the flaunting of public health regulations is, at this point, a common refrain in conversations criticizing official responses to COVID-19. According to such a perspective, the coronavirus pandemic is viewed more as a private threat to individual freedoms than a public threat to health and well-being. For various reasons (ranging from basic calculations about personal risk to outright denials of the reality of the virus as a whole), the possibility that someone could unintentionally spread the coronavirus to strangers while unmasked in public is ranked as less significant than the possibility that someone could have their personal liberties inhibited by inconvenient regulations. As some anti-mask protestors (including Representative-elect Marjorie Taylor Greene from Georgia’s fourteenth congressional district) have said: “My body, my choice,” co-opting the long-standing pro-abortion slogan to refer instead to their asserted right to keep their faces uncovered in public, without qualification.

Critics of this perspective often call it “reckless” and chastise so-called “anti-maskers” for being cavalier with their neighbors’ health; in at least one case, people have even been arrested and charged with reckless endangerment for knowingly exposing passengers on a plane to COVID-19. Against this, folks might respond by downplaying the overall effect of coronavirus morbidity: as one skeptic explained in August, “I hear all the time, people are like, ‘I’d rather be safe than sorry, I don’t want to be a grandma killer.’ I’m sorry to sound so harsh — I’m laughing because grandmas and grandpas die all the time. It’s sad. But here’s the thing: It’s about blind obedience and compliance.”

At present, the United States has registered more than 20 million cases of COVID-19 and over 340,000 patients have died from the illness; while these numbers are staggering to many, others might do some simple math to conclude that over 19 million people have (or might still potentially) recover from the disease. For those who view a mortality rate of “only” 1.5% as far too low to warrant extensive governmental regulation of daily life, they might weigh the guarantee of government control against the risk of contracting a disease and measure the former as more personally threatening than the latter. (It is worth reiterating at this point that COVID-19 patients are five times more likely to die than are flu patients — the law of large numbers is particularly unhelpful when trying to think about pandemic statistics.) Even if someone knows that they might unintentionally spread the coronavirus while shopping, boarding a plane, or partying during the holidays, they might also think it’s unlikely that their accidental victim will ultimately suffer more than they might personally suffer from an uncomfortable mask.

To be clear, the risks of contracting COVID-19 are indeed serious and evidence already suggests that even cases with only mild initial symptoms might nevertheless produce drastic long-lasting effects to a patient’s pulmonary, cardiovascular, immune, nervous, or reproductive systems. But let’s imagine for a moment that none of that is true: what if the perspective described above was completely and unequivocally correct and the Whitestone Republican Club’s recommendation to “Make your own calculated decisions, don’t give in to fear or blindly obey the media and politicians, and respect the decisions of others” was really as simple and insulated as they purport it to be?

There would still be a significant problem.

In general, we take for granted that the strangers we meet when we step out of our front door are not threats to our personal well-being. Some philosophers have explained this kind of expectation as being rooted in a kind of “social contract” or agreement to behave in certain ways relative to others such that we are afforded certain protections. On such views, individuals might be thought of as having certain duties to protect the well-being of their fellow citizens in certain ways, even if those duties are personally inconvenient, because those citizens benefit in turn from the protection of others (shirking public health regulations might then be seen, on this view, as a kind of free rider problem).

However, this doesn’t clearly explain the sort of moralizing condemnation directed towards anti-maskers; why, for example, might someone in a city far from Queens care about the choices made at the Whitestone Republican Club’s holiday party? Certainly, it might seem odd for someone in, say, central Texas to expect someone else in southeast New York to uphold a kind of give-and-take contractarian social contract!

But, more than just assuming that strangers are not threats, we often suppose that our civic neighbors are, in some sense, our partners who work in tandem with us to accomplish mutually beneficial goals. Here an insight from John Dewey is helpful: in his 1927 book The Public and Its Problems, Dewey points out that even before we talk about the organization and regulation of states or governments, we first must identify a group of people with shared interests — what Dewey calls a “public.” After considering how any private human action can have both direct and indirect consequences, Dewey explains that “The public consists of all those who are affected by the indirect consequences of transactions to such an extent that it is deemed necessary to have those consequences systematically cared for.” On this definition, many different kinds of “publics” (what others might call “communities” or “social groups”) abound, even if they lack clearly defined behavioral expectations for their members. To be a member of a public in this sense is simply to be affected by the other members of a group that you happen to be in (whether or not you consciously agreed to be a part of that group). As Dewey explains later, “The planets in a constellation would form a community if they were aware of the connection of the activities of each with those of the others and could use this knowledge to direct behavior.”

This might be why negligence in New York of public health regulations bothers people even if they are far elsewhere: that negligence is evidence that partygoers are either not “aware of the connection of the activities of each with those of the others” or they are not “us[ing] this knowledge to direct behavior.” (Given the prevalence of information about COVID-19, the latter certainly seems most likely.) That is to say, people who don’t attend to the indirect consequences of their actions are, in effect, not creating the collective “public” that we take for granted as “Americans” (even apart from any questions of governmental or legal regulations).

So, even if no one physically dies (or even gets sick) from the actions of someone ignoring public health regulations, that ignorance nevertheless damages the social fabric on which we depend for our sense of cultural cohesion that stretches from New York to Texas and beyond. (When such negligence is intentional, the social fabric is only rent deeper and more extensively). Americans often wax eloquently about unifying ideals like “E Pluribus Unum” that project an air of national solidarity, despite our interstate diversity: one of the many victims of the COVID-19 pandemic might end up being the believability of such a sentiment.

November 6, 2020December 14, 2022

Expertise and the “Building Distrust” of Public Health Agencies

photograph of Dr. Fauci speaking on panel with American flag in background

If you want to know something about science, and you don’t know much about science, it seems that the best course of action would be to ask the experts. It’s not always obvious who these experts are, but there are often some pretty easy ways to identify them: if they have a lot of experience, are recognized in their field, do things like publish important papers and win grant money, etc., then there’s a good chance they know what they’re talking about. Listening to the experts requires a certain amount of trust on our part: if I’m relying on someone to give me true information then I have to trust that they’re not going to mislead me, or be incompetent, or have ulterior motives. At a time like this it seems that listening to the scientific experts is more important than ever, given that people need to stay informed about the latest developments with the COVID-19 pandemic.

However, there continues to be a significant number of people who appear to be distrustful of the experts, at least when it comes to matters concerning the coronavirus in the US. Recently, Dr. Anthony Fauci stated that he believed that there was a “building distrust” in public health agencies, especially when it comes to said agencies being transparent with developments in fighting the pandemic. While Dr. Fauci did not put forth specific reasons for thinking this, it is certainly not surprising he might feel this way.

That being said, we might ask: if we know that the experts are the best people to look to when looking for information about scientific and other complex issues, and if it’s well known that Dr. Fauci is an expert, then why is there a growing distrust of him among Americans?

One reason is no doubt political. Indeed, those distrustful of Dr. Fauci have claimed that he is merely “playing politics” when providing information about the coronavirus: some on the political right in the US have expressed skepticism with the severity of the pandemic and the necessity for the use of face masks specifically, and have interpreted the messages from Dr. Fauci as being an attack on their political views, motivated by differing political interests. Of course, this is an extremely unlikely explanation for Dr. Fauci’s recommendations: someone simply disagreeing with you or giving you advice that you don’t like is not a good reason to find them distrustful, especially when they are much more knowledgeable on the subject than you are.

But here we have another dimension to the problem, and something that might contribute to a building distrust: people who disagree with the experts might develop resentment toward said experts because they feel as though their own views are not being taken seriously.

Consider, for instance, an essay recently written by a member of a right-wing think tank called “How Expert Worship is Ruining Science.” The author, clearly skeptical of the recommendations of Dr. Fauci, laments what he takes to be a dismissing of the views of laypersons. While the article itself is chock-a-block with fallacious reasoning, we can identify a few key points that can help explain why some are distrustful of the scientific experts in the current climate.

First, there is the concern that the line between experts and “non-experts” is not so sharp. For instance, with there being so much information available to anyone with an internet connection, one might think that given one’s ability to do research for oneself that we should not think that we can so easily separate the experts from the laypersons. Not taking the views of the non-expert seriously, then, means that one might miss out on getting at truth from an unlikely source.

Second, recent efforts by social media sites like Twitter and Facebook to prevent the spread of misinformation are being interpreted as acts of censorship. Again, the thought is that if I try to express my views on social media, and my post is flagged as being false or misleading, then I will feel that my views are not being taken seriously. However, the reasoning continues: the nature of scientific inquiry is meant to be that which is open to objection and criticism, and so failing to engage with that criticism, or to even allow it to be expressed, represents bad scientific practice on the part of the experts. As such, we have reason to distrust them.

While this reasoning isn’t particularly good, it might help explain the apparent distrust of experts in the US. Indeed, while it is perhaps correct to say that there is not a very sharp distinction between those who are experts and those who are not, it is nevertheless still important to recognize that if an expert as credentialed and experienced as Dr. Fauci disagrees with you, then it is likely your views need to be more closely examined. The thought that scientific progress is incompatible with some views being fact-checked or prevented from being disseminated on social media is also hyperbolic: progress in any field would slow to a halt if it stopped to consider every possible view, and that the fact that one specific set of views is not being considered as much as one wants is not an indication that productive debate is not being conducted by the experts.

At the same time, it is perhaps more understandable why those who are presenting information that is being flagged as false or misleading may feel a growing sense of distrust of experts, especially when views on the relevant issues are divided along the political spectrum. While Dr. Fauci himself has expressed that he takes transparency to be a key component in maintaining the trust of the public, this is perhaps not the full explanation. There may instead be a fundamental tension between trying to best inform the public while simultaneously maintaining their trust, since doing so will inevitably require not taking seriously everyone who disagrees with the experts.

September 24, 2020December 14, 2022

The Continued Saga of Education During COVID-19

photograph of empty elementary school classroom filled with books and bags

In early August, Davis County School District, just north of Salt Lake City, Utah, announced its intention to open K-12 schools face-to-face. All of the students who did not opt for an online alternative would be present. There would be no mandatory social distancing because the schools simply aren’t large enough to allow for it. Masks would be encouraged but not required. There was significant pushback to this decision. Shortly thereafter the district announced a new hybrid model. On this model, students are divided into two groups. Each group attends school two days a week on alternating days. Fridays are reserved for virtual education for everyone so that the school can be cleaned deeply. In response to spiking cases, Governor Herbert also issued a mask mandate for all government buildings, including schools. Parents and students were told that the decision would remain in place until the end of the calendar year.

On Tuesday, September 15th, the school board held a meeting that many of the parents in the district did not know was taking place. At this meeting, in response to the demands of a group of parents insisting upon returning to a four or even five-day school week for all students, the board unanimously voted to change direction mid-stream and switch to a four-day-a-week, all-students-present model. Many of these same parents were also arguing in favor of lifting the mask mandate in the schools, but the school board has no power to make that change.

Those advocating for a return to full-time, in-person school are not all making the same arguments. Some people are single parents trying to balance work and educating their children. In other households more than one adult might be present, but they might all need to be employed in order to pay the bills. In still other families, education is not very highly valued. There are abusive and neglectful homes where parents simply aren’t willing to put in the work to make sure that their children are keeping up in school. Finally, for some students, in-person school is just more effective; some students learn better in face-to-face environments.

These aren’t the only positions that people on this side of the debate have expressed. For political, social, and cultural reasons, many people haven’t taken the virus seriously from the very beginning. These people claim that COVID-19 is a hoax or a conspiracy, that the risks of the virus have been exaggerated, and that the lives of the people who might die as a result of contracting it don’t matter much because they are either old or have pre-existing conditions and, as a result, they “would have died soon anyway.”

Still others are sick of being around their children all day and are ready to get some time to themselves back. They want the district’s teachers to provide childcare and they believe they are entitled to it because they pay property taxes. They want things to go back to normal and they think if we behave as if the virus doesn’t exist, everything will be fine and eventually it will just disappear. Most people probably won’t get it anyway or, if they do, they probably won’t have serious symptoms.

Parents and community members in favor of continuing the hybrid model fought back. First and foremost, they argued that the hybrid model makes the most sense for public health. The day after the school board voted to return to full-time in-person learning, the case numbers in Utah spiked dramatically. Utah saw its first two days of numbers exceeding 1,000 new cases. It is clear that spread is happening at the schools. Sports are being cancelled, and students are contracting the virus, spreading the virus, and being asked to quarantine because they have been exposed to the virus at a significant number of schools in the district.

Those in favor of the hybrid model argue that it is a safe alternative that provides a social life and educational resources to all students. On this model, all students have days when they get to see their friends and get to work with their teachers. If the switch to a four-day-a-week schedule without social distancing measures in place happens, the only students who will have access to friends and teachers in person are the community members who aren’t taking the virus seriously and aren’t concerned about the risks of spreading it to teachers, staff, and the community at large. It presents particular hardship for at-risk students who might have to choose the online option not only for moral reasons, but also so they don’t risk putting their own lives in jeopardy. Those making these arguments emphasize that the face-to-face model simply isn’t fair.

Advocates of this side of the debate also point out that we know that this virus is affecting people of color at a more significant rate, and the evidence is not yet in on why this is the case. The children who are dying of COVID-19 are disproportionately Black and Hispanic. The face-to-face option has the potential to disproportionately impact students of color. If they attend school, they are both more likely than their white classmates to get sick and more likely to die. Many of these students live in multi-generational homes. Even if the students don’t suffer severe symptoms, opening up the schools beyond the restrictions put in place by the hybrid model exposes minority populations to a greater degree of risk.

Slightly less pressing, but still very important, considerations on this side of the debate have to do with changing directions so abruptly in the middle of the term. The school board points out that students that don’t want to take the risk of attending school four days a week can always just take part in the online option, Davis Connect. There are a number of problems with this. First, Davis Connect isn’t simply an extension of the school that any given child attends; it is an independent program. This means that if students and their families don’t think it is safe to return to a face-to-face schedule, they lose all their teachers and all of the progress that they have made in the initial weeks of the semester. Further, the online option offers mostly core classes. High school students who chose the online option would have to abandon their electives — classes that in many cases they have come to enjoy in the initial weeks of the semester. Some students are taking advanced placement or dual-enrollment courses that count for college credit. These students would be forced to give up that credit if they choose the online option. The result is a situation in which families may feel strongly coerced to allow their children to attend school in what they take to be unsafe conditions and in a way that is not consistent with their moral values as responsible members of the community.

Those on this side of the argument also point out that community discussions about “re-opening the schools” tend to paint all students with the same brush. The evidence does not support doing so. There is much that we still don’t know about transmission and spread among young children. We do know that risk increases with age, and that children and young adults ages 15-24 constitute a demographic that is increasingly contracting and spreading the virus. What’s more, students at this age are often willful and defiant. With strict social distancing measures in place and fewer students at the school, it is more difficult for the immature decision-making skills of teenagers to cause serious public health problems. It is also important to take into account the mental health of teenagers. Those on the other side of the debate claim that the mental health of children this age should point us in the direction of holding school every day. In response, supporters of the hybrid model argue that there is no reason to think that a teenager’s mental health depends on being in school four days rather than two. Surely two days are better than none.

Everyone involved in the discussion has heard the argument that the numbers in Davis County aren’t as bad as they are elsewhere in the state. In some places in the area, schools have shut down. In a different district not far away, Charri Jenson, a teacher at Corner Canyon High, is in the ICU as a result of spread at her school. The fact that Davis County numbers are, for now, lower than the rates at those schools is used to justify lifting restrictions. There are several responses to this argument. First, it fails to take into consideration the causal role that the precautions are playing in the lower number of cases. It may well be true that numbers in Davis County are lower (but not, all things considered, low) because of the precautions the district is currently taking. Other schools that encountered significant problems switched to the hybrid model, which provides evidence of its perceived efficacy. Second the virus doesn’t know about county boundaries and sadly people in the state are moving about and socializing as if there is no pandemic. The virus moves and the expectation that it will move to Davis County to a greater degree is reasonable. You don’t respond to a killer outside the house by saying “He hasn’t made his way inside yet, time to unlock the door!”

To be sure, some schools have opened up completely and have seen few to no cases. This is a matter of both practical and moral luck. It is a matter of practical luck that no one has fallen seriously ill and that no one from those schools has had to experience the anguish of a loved one dying alone. It is a matter of moral luck because those school districts, in full possession of knowledge of the dangers, charged forward anyway. They aren’t any less culpable for deaths and health problems — they made the same decisions that school districts that caused deaths made.

A final lesson from this whole debate is that school boards have much more power than we may be ordinarily inclined to think. There are seven people on this school board and they have the power to change things dramatically for an entire community of people and for communities that might be affected by the actions of Davis County residents. This is true of all school boards. This recognition should cause us to be diligent as voters. We should vote in even the smallest local elections. It matters.

July 16, 2020December 14, 2022

The Moral Challenges of Opening Up Schools During the Pandemic

As we inch ever closer to August, the question of if and how schools will open in the fall is increasingly pressing on everyone’s minds. Many decisions related to COVID-19 are presented as morally controversial when they really shouldn’t be. The issue of opening the schools, on the other hand, is complex. No matter what decision is made, some individuals and groups will experience significant hardship.

One critical question should be procedural: who should get to make decisions related to if, how, and when schools open back up? The fact of the matter is that, across the country the entities actually making the decisions, at least when it comes to public schools, are local school districts. COVID-19 is a tragedy of a sort that no one has experienced before, and there is no reason to think that local school districts know better than anyone else how to proceed. Comparatively, the number of people who are in decision-making positions in school districts is small. As a result, decisions could easily be made by a group of people who don’t believe the virus poses a significant threat.

A second approach, then, is to let communities decide. As the entire community will suffer the consequences of gathering large groups of people together in school buildings, the least we can do is give each one of those members a voice regarding if and how they would like that to happen. One problem with this, however, is that we are experiencing a strong wave of anti-intellectualism and science denial in the United States. This wave started building momentum before COVID-19 hit, but in response to the virus it has become a tsunami that threatens the lives and well-being of everyone every day. A democracy infected in this way can’t ensure just or even safe outcomes.

A third option is to let matters be settled by epidemiologists. This is a novel virus, so no one has perfect knowledge regarding what might happen in the future. Keyboard-certified “experts” flood the internet with baseless predictions that “sunlight kills the virus” or that “children can’t spread the virus.” Best, then, to leave the decisions up to the people who have dedicated their lives’ work to the study of infectious diseases in settings in which peer review and replication studies happen regularly. There are a handful of concerns for this approach as well. First, it can be tempting to think that people of science are people of dignity that are immune from political pressures. This simply isn’t so. An epidemiologist in one state may be more reliable than one in another. An alternative approach may be to act on the basis of what appears to be the consensus among experts. That said, the experts that arrive at consensus aren’t themselves going to be making the decisions in local communities, so again, the question becomes: who should be responsible for crafting policy? Since this is a decision by which everyone will be bound, it’s important that the decision is made in a way that is procedurally just.

However it turns out, the parties responsible for crafting policy will need to look carefully at the arguments, and there are compelling considerations on all sides of the issue. Right out in front is an argument that points to the intrinsic value of the lives and health of the children, teachers, and staff that will be crowded together in the school. Many people argue that the schools must reopen for the greater good. We’ll consider some of those arguments below. The response to them is to say, “life and health are not the kinds of values that should be bartered away.”

In response to concerns regarding the well-being of teachers and students, people often claim that spread of the virus to and from children is rare. Those making that argument point to studies like this one conducted in the Netherlands. One concern with the information presented there, however, is that the sample size is very small, and cases in the Netherlands never came close to approaching what we have experienced in the United States. In the United States, the circumstances simply aren’t the same. In northern Georgia, a YMCA summer camp had to shut down because 85 campers and staff tested positive for coronavirus. In Missouri, a summer camp shut down after 82 campers and staff tested positive for coronavirus. Across the country, cases of coronavirus spread at daycare facilities have been reported. In plenty of these cases, people who knew that they or their children might have coronavirus dropped their children off at daycare anyway because they couldn’t miss work. This seems like a situation that is likely to be repeated if schools open up in the fall. What’s more, the Netherlands report suggests that coronavirus has not killed any children there. Sadly, that is not true in the United States. We have the grim distinction of having more information to work with on this topic than the Netherlands does. All one has to do is search news sources for “child dies of coronavirus” to find plenty of cases.

Even if children don’t die from the coronavirus, we do know that it is possible for them to suffer severe organ damage, including brain damage. Many viruses have symptoms that only show themselves much later in life — consider the case of the chickenpox virus producing debilitating cases of shingles decades after the initial infection. Coronavirus cases might appear mild in children, but viruses can stay in the body of the carrier for their lifetime, and we don’t know enough about this virus to know what might happen down the road. Best then to err on the side of caution, social distance, and educate our children from the safety of our own homes.

Let’s imagine for a moment that children never get the virus, never pass it, or never experience any deleterious effects. The fact remains that COVID-19 clearly can be spread between adults. Adults can suffer and die from it and are doing so in great numbers. Bringing children back to school in the fall doesn’t just involve packing children into small buildings together, it involves packing adults together in close quarters too. In many cases, teachers and staff have been given no choice regarding what they would like their educational delivery method to be in the fall. This includes teachers who are immunocompromised or those who have immunocompromised loved ones for whom they care. Continued employment, especially during a recession is an immeasurably coercive force. Many people simply can’t afford to quit their jobs. These are skilled people and we should value what they do. We need them, and shouldn’t force them to work in conditions that are unsafe.

The considerations mentioned above are compelling, but there are also compelling arguments in favor of reopening. Of course, one of the most obvious arguments concerns children’s need for formal education. Some people believe that students have already experienced a developmental pause because when material was presented during the lockdown period, it was presented in less than ideal ways. Educational quality needs to improve in the fall. Of course, whether this goal can be realized depends a great deal on the area in which a person lives and the particular teacher, class, learning environment, and student in question. Some teachers went above and beyond the call of duty in planning course content that may have resonated with students better than it would have in a traditional classroom. It is a fact, however, that education in a physical setting does work better for at least some students, and this fact must be acknowledged in decision making about what to do in the fall.

Another argument for opening up the schools is that, for various reasons, parents can’t constantly be the full-time caregivers for their children. Many jobs can’t be done from home, and parents who work those jobs need a place for their children to go where they know that they will be safe and fed. Many of these people are already suffering financial hardship because of the pandemic. These people already pay taxes that fund the schools. It is a challenge for many people to find and pay for daycare in addition to everything else. On top of that, daycare situations may pose just as significant a threat as schools, so these parents would incur all of the harms and none of the benefits.

What’s more, not all children and parents have the same needs. Attending school in a physical way may be particularly important for certain special needs children. Educators trained to provide valuable resources to such children are critical in the lives of both the children and parents. Not having access to these resources might put significant strains on these households.

One way of replying to these concerns is to get creative — how might we design schooling that allows for children who need to be there to do so safely? One answer might be to offer high-quality online options to students and parents for whom that delivery method makes sense, freeing up space for in-person learning to be done in a safe, socially-distanced way. This kind of arrangement requires careful planning. Unfortunately, in many areas across the country, school districts have squandered away critical planning time while they were busy holding their collective breath hoping that the virus would disappear before it was time for the children to go back to school.

There are all sorts of considerations that are legitimate here. But there are at least three positions that are not morally defensible. First, there is no good argument for starting school in the fall with no coronavirus protections in place. Masks and social-distancing plans are a good place to start. Second, relatedly, it is not acceptable to commit the perfectionist fallacy — to say, “there are problems with all approaches, nothing is perfect, so let’s just stick with the status quo.” Though it may be true that no approach is perfect, some approaches are surely better than others. Finally, it is not morally defensible for decisions about if and how to open up schools safely to be motivated by re-election hopes, either at the local or the national level. A culture that would play politics with the lives of children and educators has truly lost its way.

May 11, 2020December 14, 2022

Utilitarian Arguments During COVID: A Symptom, Not the Answer

photograph of crowded grocery store with customers wearing masks

As the consequences of the spread of COVID-19 and of the economic recession that it has caused become slightly more clear to us, President Trump has emphasized his belief that American citizens should think of themselves as warriors as he believes that the economy should re-open, noting, “I’m not saying that anything is perfect, and yes, will some people be affected, yes, will some people be affected badly-yes but we have to get our country open and we have to get it open soon.” The upshot of this thinking is apparently that some may need to sacrifice their lives for the sake of economic recovery. Indeed, this has led many to begin analyzing this dilemma as a utilitarian one. Peter Singer has posed the issue this way, as have others urging for a re-opening. But is this really a helpful way to understand the problem being faced?

After all, even if restrictions were lifted today polls have shown that most Americans do not believe it is safe. If people are reluctant to return to work and reluctant to engage in economic activity, the economy will suffer anyways in addition to many more people dying. The choice is not between economic suffering or more death; that will happen no matter what. The choice is between how much economic suffering we can hope to mitigate and how much death we can hope to mitigate. We then have to face the “big” philosophical questions like how much a human life is worth? But consider a different moral dilemma: If an airline’s negligent policies led to a plane crash where there was no food and no hope of rescue, survivors may be faced with the prospect of eating those who died in the crash in order to remain alive. What should the public take away from an accident like this? Should it be investigating what policies need to be in place to prevent future crashes and to ensure that if one does occur that there are rations for survivors, or should the upshot of such an ethical dilemma be that there is a utilitarian argument for eating Steve? How should we define the problem?

According to American philosopher John Dewey, one of the defining characteristics of the scientific revolution is when we stopped taking observed phenomena as the final or conclusive by itself, and started to see them as problems to be experimentally investigated in terms of the means required to produce them and the effects that they produce. If we perceive a stick that bends as it is placed in water, we do not claim to know that the stick bends in water; the perception creates a problem for investigation in terms of how optics allows for such a perception. It is this intelligent investigation into the relationship between means and ends that allow us to control and regulate our experiences. Applying this lesson to ethics, Dewey notes in Experience and Nature that when we take what we value to be a problem, “it implies intelligent inquiry into the conditions and consequences of a value-object.” What does this tell us about how to define moral problems?

The present situation may lead us to believe that we are facing an ethical problem with two conflicting aims: do we re-open the economy in order to help reduce long-term suffering or do we keep lock-down regulations in place to prevent more deaths? The question has been posed by even the likes of Anthony Fauci who asked this week, “How many deaths and how much suffering are you willing to accept to get back to what you want to be some form of normality sooner rather than later?” As noted, either way there will be suffering and pain and we can try to figure out ways to mitigate that suffering, but perhaps the lesson to be learned is not how to choose between these conflicting aims, but how to prevent those aims from conflicting in the first place. The dilemma being faced between economic suffering on the one hand, and death on the other is not the definition of the ethical problem, but a symptom of it. When we examine the conditions that lead to this conflict and the consequences that follow from it, the moral conclusion to reach is determining what steps are necessary to prevent a conflict between keeping people alive and preventing economic disaster in crises like these.

It is no secret that one of the factors which exacerbates the dilemma between economic health and public health is the rise in economic desperation. Unemployment rates are hitting levels associated with the Great Depression. Food banks are being overwhelmed. 20% of Americans were unable to pay rent for May. It is no wonder that a growing number is desperate to return to work and this urgent need only makes the problem worse. But even before this year roughly 40 million people depended on food banks. Millions lived paycheck-to-paycheck and 30% of adults had no emergency savings. There are plenty of ways of measuring a successful economy, but had there been greater efforts to secure the economic stability of average citizens, the crisis they are facing would not have been as bad.

Government policies to help citizens facing an economic crunch is one way to help mitigate the problem. However, for most Americans a single $1200 check is insufficient. In Canada, the government response has been more comprehensive: the Canada Emergency Response Benefit (CERB) is providing $500 a week for 16 weeks. The government is also subsidizing wages to ensure that employees can retain their jobs. Efforts like this are a help in removing some of the urgency of re-opening compared to the situation in the United States, but such policies cannot be maintained forever. One of the lessons that perhaps should be learned is to focus less on isolated figures like GDP growth or unemployment rates, and more on ensuring individual economic security against threats to economic activity (this includes a potential second-wave, a future virus, armed conflict, or even climate change).

On the public health side of the dilemma there are also lessons that could be learned. In January, most public figures in North America were still downplaying the threat of the coronavirus. As a result, travel continued unabated, medical equipment was not stockpiled, and the public was not given a heads up about what was coming. As Fauci has admitted, the slow response did cost lives. Had governments and other institutions responded faster, the crisis would not be what it is now. The hard-moral work moving forward is going to be figuring out the conditions that were in place that allowed the problem to become worse. For example, the Trump Administration has no bio-ethics committee (something presidents have had going back to the 1970s). Such a board can help policy makers understand the potentially relevant ethical issues relating to preparation for a public health crisis. Improving methods of handling similar health crises may help prevent them from becoming serious threats to the economy.

The moral imperative for the public is not to go out and consume, but to make sure that that policy makers have plans in place to prevent the next crisis from becoming as bad. Much of this does not help the current dilemma, but that is sort of the point. Allowing the problem to get this bad means that options become limited, time becomes limited, and it makes the public more likely to panic and make rash decisions. Looking to utilitarian ethics in this situation is like relying on a rope made of bedsheets to escape a 10-story apartment fire; it may be a valid option (or not), but ultimately the wise thing is to make sure that future apartments have an adequate sprinkler system so that we do not need bedsheet solutions.

April 30, 2020December 14, 2022

Anti-Lockdown Protests: Private Liberty v. Common Good

photograph of family at Open Ohio protest

Thousands of Americans across various states have decided to take a stand against the lockdown measures imposed on them as the COVID-19 pandemic sweeps across the nation. In a particularly large protest in Washington state’s capital of Olympia, over 2,000 people gathered to fight for relaxed rules for the economy. Others have been much smaller—such as the 200 people who gathered outside of Indiana Governor Eric Holcomb’s residents to show their disapproval of the strict stay-at-home orders. Protesters carry signs with slogans ranging from “Land of the Free” to “The cure is worse than the virus” to “Let me work.” They often are advocating for an ease in lockdown measures, a reopening of the economy, and the opportunity to return to their jobs. They feel as if the government has restricted their freedoms too much, and are fighting for their rights. Protesters are using their right to freedom of expression to fight for their right to assemble, as well as the ability to work to earn money for their families. However, many protesters do not follow social distancing restrictions or wear masks, per Dr. Fauci and the National Institute for Health’s recommendations. Some experts worry that their protesting could lead to an increase in COVID-19 cases, more deaths, and possibly a prolonged quarantine period. This issue has sparked debate and controversy across the country. Technically, protesters are exercising their constitutional and basic human rights. Yet, is it ethically correct for them to do so, if it could make others sick—possibly killing some?

There is no easy or straightforward way to answer that question. To grasp the moral conflict at play, one must understand the idea of collective action. Managing the risks of the current crisis will require a concerted group effort. Unfortunately, what individuals perceive as their best interest is sometimes at odds with what is in the best interest of the group. Achieving the best public health outcomes for everyone involved may require individuals to forgo some of their rights, their jobs, and social lives. For example, it may be in the individual’s best interest to buy as many masks as possible to protect himself from the virus, but hoarding masks will cause a shortage for others, especially those that need them (such as healthcare workers). This situation gives each person the opportunity to benefit themselves, while spreading the negative consequences of their actions across the larger population.

This tension between the need for collective action and the exercise of individual rights is at the heart of the recent protests in America. Protesters are looking for what is in their best interest—exercising their constitutional freedoms, returning to their places of business, and seeing their friends and family—while the entire community will share any negative outcomes of their protesting. We can examine this problem by looking at both sides of the argument.

Let’s start with the protester’s point of view. There have been signs that America is reaching “the top of the curve,” and infection rates have decreased in some states. Yet, there is no sign that the strict lockdown measures that Americans have lived under for weeks will be loosened anytime soon. The protesters are people fighting for their freedom—and they have valid reasons to do so. All citizens of the United States have had some of their basic freedoms restricted in the hope of slowing the spread of the virus. There are curfews, business closures, and church gathering bans. They have no right to freedom of assembly, and have been heavily encouraged to wear masks. Many have lost their jobs because of lockdown measures—over 6.65 million Americans filed for unemployment at the start of April. Protesters want their normal lives and freedoms back. They want to be able to work to earn money for their families.

Many protesters don’t believe that their rights should be taken just because the government says so. And they have taken a stand to show their disapproval. For example, a protester in California stated that “We need our freedom back, we need to be able to work, we need to be able to socialize, as soon as we can.”

Many protesters share the opinion that the government has been too controlling over their lives and decisions—some have stated that the prolonged lockdown is “basically slavery.” They feel as if the government is being too intrusive without giving them a say in the matter. One protester went as far to say that the California governor Gavin Newsom is a “dictator” for promoting strict lockdown measures. California residents have experienced one of the strictest stay-at-home orders in the country—receiving countless alerts on their phones from the government promoting social distancing, staying at home, and closing businesses. They are only allowed to leave their house for “essential needs/work,” and their governor shows no sign of easing restrictions anytime soon. This can be seen as an invasion of privacy and a violation of their rights.

Some other protesters feel that it is the obligation of the government to try to “fix” the problems that the lockdown has caused. The quarantine that the government issued has negatively impacted private and small businesses, as well as citizens’ livelihoods. This means that the government may have to be the one to fix or mitigate the damages that their lockdown caused. However, many citizens have had economic troubles because the relief bill assistance has been slow to arrive. And it is not only citizens marshaling these arguments, Missouri Senator Josh Hawley has stated that the government is responsible for offsetting what lockdown measures have cost the country.

Others simply feel that lots of the government requirements and action taken are unnecessary. The 2019 novel coronavirus is usually only fatal to those with compromised immune systems or those with old age. Protesters don’t feel as if they, as healthy individuals with strong immune systems, should be stuck at home, unable to work and live relatively normal lives. The signs they carry (“Quarantine the sick, not the healthy”) show this sentiment. Protesters in rural areas also feel as if the lockdown measures aren’t as necessary where they live, as their population is less condensed as it is in big cities, making it harder for the virus to spread.

And while many protesters gathered in large crowds without masks, ignoring safety recommendations, many others have not. There are protesters who wear masks, or who have been protesting in their cars instead of gathering with other people.

However, many people disagree with the protests. They believe that protesters are not taking proper precautions to protect against the disease, and they could cause an increase in cases, deaths, and possibly increase the quarantine period.

“Give me liberty or give me death” is a frequent slogan in protest. But as many have suggested, protesters could be “campaigning for both.” It is a fact that many protesters, especially in news footage, were not following social distancing precautions. They were gathered in crowds as large as 2,500 and most were not wearing masks to prevent spreading the virus. Experts worry that these anti-quarantine protests can cause a surge in COVID-19 cases. Rachel Revine, the Pennsylvania State Health Secretary, stated that “This is how COVID-19 spreads,” when talking about the protests. Eric Feigl-Ding, an epidemiologist and public health scientist at the Harvard TH Chan School of Public Health, tweeted that he predicts a “new epidemic surge” with an incubation period of about 5-7 days before the onset of any symptoms and transmission, concluding that there will likely be “[an] increase in 2-4 weeks from now” of cases in America.

Some nurses who do not support the protests have also made their opinions known. A few (in Harrisburg, Pennsylvania and in Denver, Colorado, to name a few) have stood in a counter-protest at crosswalks, blocking the cars of angry protesters. In Michigan, many healthcare workers have complained that the protests caused them to arrive late to work. Some ambulances have had a slight delay in reaching the hospital because of the gridlock protests.

Others simply don’t agree with the message of the protests. They feel as if strict lockdown measures should still be in place. America has been the center of the pandemic, with over 735,000 known cases and 40,000 known deaths nationwide. Many don’t feel that their country is ready to re-open. For example, Rachel Revine said that there needs to be a decrease in cases and an increase in the amount of tests produced, stating that “the idea that we can ease up is exactly the wrong answer.”

Yet one of the main reasons that people are not pleased with the recent protests is because they feel as if the protesters are not thinking about the common good. Protestors carry signs saying “My body, my choice.” But, is it really their choice? Their actions could lead to an increase of coronavirus cases, and possibly fatalities, in their community.

It all comes back to the idea of collective action. The individual protester sees it in their best interest to protest for their own rights, and for their own ability to work—they fully have this right to freedom of expression. But many protesters aren’t asking themselves what the possible costs of their actions could be. By gathering in large crowds without masks to protest for what is in their own short-term benefit, they could cause an increase in COVID-19 cases. This can risk the lives of everyone in the community, and undoes a lot of the “progress” made under the quarantine.

Could we outwit human nature’s phenomenon of collective action? It would involve us as individuals sacrificing some of our own wants for the good of the community. Protesters may have to use social media or other digital platforms to have their voices heard and make a stand without endangering the vulnerable people in their community.

This coronavirus pandemic is a difficult time for all of us. We’ve stayed inside for weeks, many without jobs or people to interact with, to help “flatten the curve.” And now, as people call for change through protests, we may run the risk of increasing COVID cases. In the midst of the uncertainty and the controversy, one thing is for certain: We need to ask ourselves what possible costs our actions have for others. We must consider the phenomenon of collective action—are we acting in the interest of our own individual short-term pleasure, only for the entire community to share the negative effects of our actions? In this case, only time will tell.

April 28, 2020December 14, 2022

Is Now the Time for an Economics Code of Conduct?

photograph of various banknotes from around the world

One complication of the coronavirus crisis is that it requires that policy decisions weigh public health issues against economic concerns. Economic advisors should be conscious of their own uncertainty as well as the significant and long-term consequences for those acting on their advice. A recent problematic example includes economic advisor Peter Navarro attempting to influence decision making over the use of hydroxychloroquine as a “cure” by claiming his background in statistics made him qualified to address public health matters. While I suspect few would agree with this kind of policy advising, economist advisors still have a vital role to play in conversations regarding the reopening of the economy. Now that the projected infection rates and fatalities of COVID-19 have been revised downward in many regions, concern has shifted to how and when the economy should be restarted. Economic advisors will give advice (and have now given) that could have significant public health consequences. This raises the following question: Given that other professions who work for the public good must adhere to codes of professional ethics, is it time for economists to do the same?

First, we need to consider in general terms why this issue is so pertinent now. With mounting job losses and a prolonged period without production, some of the economic forecasts are grim. The risks are so great the economic downturn could mirror the Great Depression. The hope is that once restrictions are rescinded, we will be facing a “V-shaped” recession where a sudden downturn is followed by a sudden upswing. But the longer the restrictions are in place, the greater risk there is that the economy will take longer to recover. Alternatively, there is the risk that if restrictions are lifted too soon, there will be a second wave of infections without a vaccine. This appears to pit economic concerns against public health concerns, however, the problem is complicated by the fact that a recurring public health crisis would be even more costly to the economy than the current downturn. According to economist Andrew Atkeson, if the epidemic continues to grow the economy will grind to a halt anyways. Even if reopening the economy is warranted, such efforts will be problematic for economic and public health if it is done haphazardly. Economic advising always involves ethical issues, but it is this current question that highlights the ethical significance that policy advice can have.

One might expect that economists, given their potential to bring about significant ethically salient consequences, would have an ethical code to turn to. Such codes are common in other professions which are relevant to the public good. For example, engineering students in Canada and in the United States graduate with a ceremony where they recognize their ethical obligations to the discipline and to the public good, and they wear a ring as a symbol of their commitment to those obligations. Other fields (accountants, lawyers, journalists, and more) are bound by professional codes of conduct. In Western medicine, it is common for students to affirm the Hippocratic Oath. Many of these professional codes stress the importance of nonmaleficence, professional integrity, transparency, and accountability. Economists have no such oaths which they are expected to affirm or swear by.

Of course, one may ask why any kind of professional code of ethics, particularly when it comes to policy advice, is necessary? According to a value-free ideal of science, the conduct of research and the application of research are two different things. In order to keep the study of economics as non-political and value-free as possible, economists must only consider the accuracy of their findings and report those findings accurately to policy makers; after that, the political and ethical concerns belong to policy makers alone. For example, in his 1956 paper “Valuation and Acceptance of Scientific Hypotheses” Richard C. Jeffrey argues that scientists are only supposed to assign probabilities to hypotheses and then allow the acceptance of these hypotheses to be a matter of public acceptance. So, economists should be isolated from policy making and concerns about the public good as their only function is merely to analyze the data.

This argument became prominent in many different forms in the 20th century. Robert Nelson, an economist who formerly worked in the Office of Policy Analysis in the Office of the Secretary of the Interior for almost 20 years, notes in his own working experiences the force that this thinking had. Identifying the desire to clearly separate science from politics as a matter of progressive-era thinking, he notes that while this was the expectation, it was never a matter of practice. He explains:

“Economy policy analysts in government, as I was discovering, were not simply told to study the technical means of implementing a given policy and to report the scientific results back to their superiors. Rather economy policy analysis often functioned themselves as strong advocates for particular policy positions.”

Part of the problem, as Nelson explains it, is that there is a gap between democratic institutions and the degree of expertise required to make complex choices. An expert-policy advisor cannot simply analyze the data and relay their findings because neither the public nor many of these decision makers have the expertise to know what to do with that information. This creates a practical obstacle to the value-free ideal.

In addition, the mere use of certain data or certain statistical indicators can have political salience. As Susan Offutt notes, measurements like unemployment can have political consequences. But so does a lack of agreement on how to measure poverty or a “green” GDP. Deciding what is measured and how is a matter for economists to determine. The analyses found in policy advising are already politically influential even if it is the policy makers who ultimately decide what to do with that information.

Economic advisors right now need to balance a number of concerns. Should the focus be on securing public health? Should the focus be on economic growth? Should personal liberty be a factor? Some of the arguments for establishing an ethical code for economists draw analogies between fields like medicine and environmental policymaking. For example, like the field of medicine there is a distinction between experts and those who are the target of that expertise. This creates asymmetries in power, status, and knowledge. In a doctor-patient relationship this asymmetrical relationship creates ethical responsibilities for the physician to do no harm to a patient. This means that they recognize the degree of uncertainty before advising and recommending treatments, and do not arbitrarily violate the patient’s expressed wishes.

In contrast, economist George DeMartino has argued that economists working for institutions like the IMF, the World Bank, and others have pursued policies on the basis of optimal anticipated outcome rather than risk of failure. He describes how for decades inhabitants of developing countries have been subject to policies based on this thinking and have suffered for it. He explains:

“The 1980s inaugurated an extraordinary, sustained period of avoidable human suffering in the South, a chief cause of which was the failed neoliberal experiment. I use the word ‘experiment’ purposefully, since it seemed clear then and certainly does now that this was an instance in which economists took advantage of an extraordinary, historically unprecedented opportunity to design and test-drive a shiny new economic model over the objections of what were essentially unwilling subjects across the South.”

Would it be ethical for a doctor to advise risky treatments and then to have them carried out against a patient’s wishes? No. So, why should economists be treated differently if they are capable of causing harm on a large scale? Even if medical codes of ethics are not suited to economics, the relevant differences between medicine and economics do not lead to the conclusion that ethics should be of no concern to the economist.

Returning to our current crisis, stop and think about the potential for death, poverty, unemployment, misery, and suffering that is riding on the decisions which are being influenced by policy advisors right now. Should these people be held accountable to an ethical code of conduct?

In his 2005 paper DeMartino notes that despite the power and responsibilities that economic advisors can wield, there is no professional ethics body within the field of economics. Even today, prestigious economics programs at MIT and Princeton do not require economic ethical training. At the end of his paper, DeMartino’s prospective “Economist’s Oath” makes reference to using one’s power for the community good, it specifies that communities are not mere means to ends, and it declares that economics is an imperfect science that carries risks and dangers. Much of what this means in practice would need to be clarified over time, but as a resource to turn to, it could be a promising start. Given that many of these dangers and risks are now present in the COVID-19 crisis, the time may have come when the public should not only expect that economic advisors follow an economics ethical code, they should demand it.

April 17, 2020December 14, 2022

Racial Health Disparities and Social Predispositions

photograph of Surgeon General Adams at podium during coronavirus briefing

Remarks made by U.S. Surgeon General Jerome Adams at last week’s coronavirus press briefing have sparked a heated debate. Most of the commentary surrounding those remarks has focused on accusations of patronizing language or, alternatively, the ever-expanding grip of PC culture. But the real controversy lies elsewhere. The true significance of the Surgeon General’s words rests in parsing ambiguous language; we need to know what is meant by the observation that people of color are “socially predisposed” to COVID-19 exposure, infection, and death.

The Surgeon General’s comments were aimed at addressing a troubling trend. Statistics continue to pour in underscoring racial health disparities: The population of Chicago is 30% Black, but Black people make up 70% of the city’s coronavirus deaths. Similarly, in Wisconsin’s Milwaukee County, African Americans make up 25 percent of the population, but 75 percent of the confirmed deaths. In Louisiana, Black people make up 33 percent of the population, but account for 70 percent of deaths.

What could explain these figures? Adams highlighted several of the underlying factors placing Black Americans at greater risk: they are more likely to have complicating conditions such as diabetes, high blood pressure, and heart disease, as well as being more likely to lack access to health care. All of these factors mean that Black Americans are “less resilient to the ravages of COVID-19.”

What is more, people of color, generally, are also more likely to be exposed to infection in the first place. They are more likely to live in multi-generational homes, reside in high-density housing, and make up “a disproportionate share of the front-line workers still going to their jobs.” As Jamelle Bouie explains,

“Race […] still answers the question of ‘who.’ Who will live in crowded, segregated neighborhoods? Who will be exposed to lead-poisoned pipes and toxic waste? Who will live with polluted air and suffer disproportionately from maladies like asthma and heart disease? And when disease comes, who will be the first to succumb in large numbers?”

Skeptics continue to contend that it is reductionist to blame racism for these inequities, and offer in its stead the familiar trope of private behavior and individual choice. But casting the problem as one of personal responsibility not only overlooks the history of systemic racism and structural socioeconomic oppression — that define things like one’s housing and job opportunities which in turn determine one’s relation to this disease — it perpetuates the false narrative that the sufferer is responsible for her suffering.

And that is the problem of the language of “social predisposition,” and the subtle claim that word choice makes in regards to responsibility for racial health disparities. (If you were biologically or genetically predisposed to infection how much responsibility would you bear for contracting it? How much responsibility do you bear by being “socially predisposed”?)

One the one hand, “social predisposition” can be read as vaguely acknowledging the history of institutional racism and the consequences it has wrought (and continues to work). Structural forces have conspired (consciously and unconsciously) to disadvantage minorities and enshrine differential access to goods and opportunities on the basis of skin color. On the other hand, “social predisposition” can just as easily be understood as gesturing at social habits, predilections, and weaknesses.

Does such fine analysis of the Surgeon General’s comments make a mountain of a molehill? John McWhorter of The Atlantic, for example, describes this type of criticism of Adams’ remarks as overblown. It is inappropriate and impractical, McWhorter argues, to insist that every talking head reference the prescribed origin story whenever a racial disparity arises. “Members of a certain highly educated cohort,” McWhorter writes, “consider it sacrosanct that those speaking for or to black people always and eternally stress structural flaws in America’s sociopolitical fabric past and present as the cause of black ills.” What’s worse, “writers and thinkers give an impression that their take is simple truth, when it has actually devolved into a reflexive, menacing brand of language policing.”

But the Surgeon General’s remarks cannot themselves be regarded as neutral. The message behind “social predisposition” is ambiguous without context. But when it gets coupled with a plea aimed directly at people of color to change their habits concerning drugs and alcohol because “we need you to step up,” it starts to sound a lot less ambiguous. It threatens to transform the claim about “social predisposition” from a statement about constraining factors to a question of volition. It moves from the language of preexisting conditions to elective tendencies. It reduces structural injustice to a matter of choice.

It also changes our conversation about the link between race and health outcomes from one of correlation to one of causation. Thus, it seems only fair that other potential “causes” should get a hearing. It may not be within the Surgeon General’s purview as a public servant for national health to comment on the root cause of social injustices, but then it can’t be within his purview to subvert that project either. Even if his intention was merely to offer “wise counsel in hard times,” it matters how that advice gets heard and who all hears it.

July 15, 2019December 14, 2022

Vaccination Abstention and the Principle of Autonomy

image of 1960's polio vaccine poster with Wellbee Cartoon

The suppression or eradication of many serious diseases in vaccinated populations has been one of the great public health successes of the twentieth century. There have always been those who resist or refuse vaccination for a variety of religious, political, or health reasons. Though there can be some risk of negative reactions to vaccines in certain individuals, vaccination is very safe for the general population. Continue reading “Vaccination Abstention and the Principle of Autonomy”

April 12, 2019December 14, 2022

The Ethics of Philosophical Exemptions

photograph of syringe and bottle of antiobiotics

While every state in America has legislation requiring vaccinations for children, every state also allows exemptions. For instance, every state allows a parent to exempt their child from vaccinations for legitimate medical reasons: some children with compromised immune systems, for example, are not required to be vaccinated, since doing so could be potentially harmful. However, many states also allow for exemptions for two other reasons: religious reasons, and “philosophical reasons.” While religious exemptions are standardly granted if one sincerely declares that vaccinations are contrary to their religious beliefs, what a “philosophical reason” might consist in varies depending on the state. For example, Ohio law states that parents can refuse to have their children immunized for “reasons of conscience”; in Maine a general “opposition to the immunization for philosophical reasons” constitutes sufficient ground for exemption; and in Pennsylvania “[c]hildren need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization…on the basis of a strong moral or ethical conviction similar to a religious belief” (a complete list of states and the wordings of the relevant laws can be found on the National Conference of State Legislatures website).

Of course, not all states grant exemptions on the basis of any reason beyond the medical: California, Mississippi, and West Virginia all deny exemptions on the basis of either religious or philosophical reasons. And there seem to be plenty of good reasons to deny exemption except only in the most dire of circumstances, since vaccinations are proven to be overwhelmingly beneficial both to individuals, as well as to the community at large by contributing toward crucial herd immunity for those who are unable to be vaccinated due to medical reasons.

At the same time, one might be concerned that, in general, the law needs to respect the sincere convictions of an individual as much as possible. This is evidenced by the fact that many states provide religious exemptions, not only for vaccinations, but in many other different areas of the law. Of course, while some of these exemptions may seem reasonable, others have become the target of significant controversy. Perhaps most controversial are so called “right to discriminate” conditions that, for example, have been appealed to in order to justify unequal treatment of members of the LGBT community.

While there is much to say about religious exemptions in general, and religious exemptions to vaccinations in particular, here I want to focus on the philosophical exemptions. What are they, and should they be allowed?

As we saw above, the basis for granting philosophical exemptions to vaccinations seems to simply be one’s sincere opposition (how well-informed this opposition is, however, is not part of any exemption criteria). In practical terms, expressing philosophical opposition typically requires the signing of an affidavit confirming said opposition, although in some cases there is the additional requirement that one discuss vaccinations with one’s doctor beforehand (Washington, for example, includes this requirement). In general, though, it is safe to say that it is not difficult to acquire a philosophical exemption.

Should such exemptions exist? We might think that there is at least one reason why they should: if sincere religious conviction is a sufficient basis for exemption (something that is agreed upon by 47 states) then it seems that sincere moral or philosophical conviction should constitute just as good of a basis for exemption. After all, in both cases we are dealing with sincere beliefs in principles that one deems to be contrary to the use of vaccinations, and so it does not seem that one should have to be religious in order for one’s convictions to be taken seriously.

The problem with allowing such exemptions, of course, is the aforementioned serious repercussions of failing to vaccinate one’s children. Indeed, as reported by the PEW research center, there is a significant correlation between those states that present the most opportunity to be exempted – those states that allow both religious and philosophical grounds for exemption – and those that have seen the greatest number of incidents of the outbreak of measles. Here, then, is one reason why we might think that there should be no such philosophical exemptions (and, perhaps, no exemptions at all): allowing such exemptions results in the significant and widespread harm.

The tension between respecting one’s right to act in a way that coincides with one’s convictions and trying to make sure that people act in ways that have the best consequences for themselves and those around them is well-explored in discussions of ethics. The former kinds of concerns are often spelled out in terms of concerns for personal integrity: it seems that whether an action is in line with one’s goals, projects, and general plan for one’s life should be a relevant factor in deciding what ought to be done (for example, it often seems like we shouldn’t force someone to do something they really don’t want to do for the benefit of others). When taking personal integrity into account, then, we can see why we might want there to be room for philosophical exemptions in the law.

On the other hand, when deciding what to do we also have to take into account will have the best overall consequences for everyone affected. When taking this aspect into consideration, it would then seem to be the case that there almost certainly should be only the bare minimum of possibility for exemptions to vaccinations. While it often seems that respecting personal and integrity and trying to ensure the best overall consequences are both relevant moral factors, it is less clear what to do when these factors conflict. To ensure the best consequences when it comes to vaccinations, for example, would require violating the integrity of some, as they would be forced to do something that they think is wrong. On the other hand, taking individual convictions too seriously can result in significantly worse overall consequences, as what an individual takes to be best for themselves might have negative consequences for those around them.

However, there is certainly a limit on how much we can reasonably respect personal integrity when doing so comes at the cost of the well-being of others. I cannot get away with doing whatever I want just because I sincerely believe that I should be able to, regardless of the consequences. And there are also clearly cases in which I should be expected to make a sacrifice if doing so means that a lot of people will be better off. How we can precisely balance the need to respect integrity and the need to try to ensure the best overall consequences is a problem I won’t attempt to solve here. What we can say, though, is that while allowing philosophical exemptions for vaccinations appears to be an attempt at respecting personal integrity, it is one that has produced significant negative consequences for many people. This is one of those cases, then, in which personal conviction needs to take a backseat to the overall well-being of others, and so philosophical reasons should not count qualify as a relevant factor in determining exemptions for vaccinations.

March 26, 2019December 14, 2022

The Ethics of Vaccination Exemptions

On January 28, 2019, Washington Governor Jay Inslee declared a state of emergency in response to a spreading outbreak of measles in Clark County, WA. Measles is a highly contagious airborne infection caused by a virus in the paramyxovirus family. Before a vaccine was developed in 1963, the disease infected over 3 million people a year in the United States and resulted in 400 to 500 deaths annually. In 2000, thanks to a highly effective vaccination system in the U.S., the measles disease was declared eliminated by the Center for Disease Control. However, measle outbreaks have begun to emerge again in recent years due to a growing number of parents who refuse to vaccinate their children—often falsely claiming that vaccinations are either unsafe of unnecessary. Do parents against vaccinations, also called “anti-vaxxers,” have a legal right to refuse vaccinations for their children even if it means jeopardizing public health?

While the history of the anti-vaccination movement can be traced all the way back to the 1800’s, a study released in 1998 that claimed a false link between the measles vaccinations and autism has fueled much of the contemporary anti-vax fire. Author of the study, British doctor Andrew Wakefield, was found to have been paid by a law board to falsify evidence in support of a litigation case that claimed vaccines had harmed children. The study was formally retracted by its publisher in 2010 and Wakefield lost his licence to practice medicine in Great Britain. Since then, numerous studies (including one released on March 5th, 2019) have failed to find any link between vaccines and autism.

There are legitimate medical reasons to delay or avoid vaccinations, but they are rare. While some doctors have decided to profit off the anti-vax craze by selling false medical exemptions to parents, most who refuse vaccinations for their children do so through non-medical, state-issued means. Most common is an exemption based on “religious beliefs.” Overall, no major world-religion has a theological objection to vaccinations. However, certain offshoots of ‘faith-healing’ denominations, such as Christian Science, reject modern medicine altogether. Some religious fundamentalists also claim that vaccines are unnecessary. Gloria Copeland, an Evangelical Christian minister who sat on the Trump campaign’s evangelical advisory board, claimed in a 2018 video on Facebook that Jesus was the best protection against the flu and people can avoid the disease by repeating “I’ll never have the flu.”

Many states also allow for “philosophical” or “personal” vaccine exemptions that do not require religious backing. Much of the motivation to acquire such exemptions stems from the spread of misinformation on social media sites like YouTube, Facebook, and Pinterest. Ethan Lindenberger, an Ohio teen who chose to get vaccinated against his parents wishes spoke of the necessity in addressing misinformation when he testified before congress on March 4th, 2019. Lindenberger said, “For my mother, her love, affection and care as a parent was used to push an agenda to create a false distress, and these sources which spread misinformation should be the primary concern of the American people.”

Non-medical vaccine exemptions (NMEs) endanger public health by reducing “herd immunity.” No vaccine is 100% effective, but when a population is highly vaccinated it prevents the spread of germs from one person to another—effectively protecting the population. The less vaccinated a population becomes the more susceptible both vaccinated and unvaccinated individuals are to diseases. This is why public schools require vaccinations for children who attend. In 2015, the Second Circuit U.S. Court of Appeals in Manhattan upheld a ruling that students who receive religious exemptions can be kept out of the classroom during a disease outbreak. The court stated, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or to the latter to ill health or death.”

Proponents of NMEs believe public health should not take precedence over individual liberties and that mandated vaccinations are a threat to personal autonomy. However, in the case of public spaces, such as schools, vaccines are analogous to other government mandated safety measures. Exceeding the speed limit, running a red light, or breaking other rules of the road is illegal when driving because it threatens the safety of others. The famous ‘harm principle’ of British political theorist John Stuart Mill argues that infringing on personal liberties is justifiable when it protects others from harm. Under this principle, vaccination exemptions should be highly restricted since they pose a threat to public health.

Dr. Barbara McAneny, the American Medical Association’s president, argues, “Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation.” A 2013 measles outbreak in Brooklyn, New York that infected 58 people was caused by a single unvaccinated child. Such an incident shows that, to keep a population best protected from disease, vaccination exemptions should only be allowed for legitimate medical reasons. While preventing the spread of misinformation is paramount to combating the rising rates of NMEs that are endangering both domestic and global health, the most effective means of reducing communicable disease is to do away with NMEs all together.

September 14, 2017January 23, 2024

Rules Versus Results in Vaccine Research

A photo of a person withdrawing medicine from a vial with a syringe

This article has a set of discussion questions tailored for classroom use. Click here to download them. To see a full list of articles with discussion questions and other resources, visit our “Educational Resources” page.

A group called Rational Vaccines, which conducted a clinical trial of a herpes vaccine, has brought legal and ethical standards for medical research into the news recently. The trial, conducted from April to August of 2016, used human subjects and was conducted in the Caribbean in order to avoid being overseen by the FDA or cleared by the institutional review board, or IRB, which is required of trials in the US.

Peter Thiel, co-founder of PayPal, has invested $4 million in Rational Vaccines this month. Thiel is an outspoken critic of the safety regulations the FDA and considers the oversight of the organization to needlessly delay scientific advancement. In an interview, he claimed that our current system of checks would prevent the polio vaccine from being developed today. However, his contribution to the group was contingent on their future compliance with FDA regulations in order for the findings of their research to be able to help more people.

The group has faced a great deal of controversy over the herpes vaccine study, not only for blatantly avoiding the jurisdiction of the US, but also for failing to meet standards of scientific rigor. However, the Chief of Rational Vaccines, Augustin Fernandez, stands by the results and is concerned that the import of the study is being lost in the uproar over the conditions of the trial.

Medical research has the aim of advancing our understanding of treatment and developing new ways of preventing ailments and healing the sick. However, this aim is in conflict with a competing value: that of imposing risk to the subjects. Clinical trials in medicine are experiments that explore what happens when humans engage in some treatment, and thus expose humans to risk of harm. Medical research thus has its own burden of justification that other scientific research (for instance, in physics or chemistry) doesn’t necessarily need to meet.

A basic ethical burden for medical research is that of scientific merit: a study must meet the standards of scientific method that peers dictate. Because studies are taking place in a scientific context, ideally this includes some possibility of replication of the results, suitable sample size and distribution, and objectivity of data collection. Including a control group and controlling variables is similarly important. Because clinical trials are exposing humans to harm, the study needs to be of scientific merit. Unfortunately, the herpes vaccine trial is not clearly meeting these standards because it included only 20 subjects without a clearly established control group, and the results involved the subjects who received the vaccine self-reporting their impression of whether there was an improvement of their condition. These aspects have undermined the scientific merit of the study, making it unlikely to be published in the US.

Also, because the research is experimental in nature, meaning it is not the standard of care, it is thus risky, and there are ethical demands on how this risk must be managed. Because humans are involved and potentially harmed by the trial, when medical research is conducted on humans, the subjects must give informed consent to adopting the risk of the study.

Other ways of managing the risk of the study go beyond the consent of the participants. The possible benefit must be proportional to the risk assumed by the subjects. Further, the benefit must not be directed towards a different group than those assuming the risk. This concern ties into selecting the subjects. If the treatment or drug that results from the trial will be prohibitively expensive, for instance, then it is ethically fraught to test the drug on subjects from economically disadvantaged groups. It may save a significant amount of money to conduct research on new treatments in less developed areas or nations, but to do so often means centering the risk of the trials on groups that will not be able to benefit from the results.

This ethical constraint on medical trials is especially pertinent to studies being conducted transnationally. In Rational Vaccine’s trial for this herpes vaccine, subjects from the US and UK were flown to the Caribbean to take part in the study so this concern doesn’t overtly arise. However, transferring their patients outside the country highlights their attempts to avoid government regulations.

The criticisms that Thiel and other libertarians lob against the FDA claim that the regulations prevent medical progress. That’s true. Regulations are meant to promote the aims discussed above in order to prevent harm and exploitation of human subjects. In conducting research, the tension between developing a life-saving treatment and conducting your trial in a respectful and ethical manner can be fraught.

Unfortunately, the history of clinical trials is riddled with cases that highlight how important it is to attend to the ethical implications of medical research. It is very possible to conduct research in countries with fewer regulations and underprivileged citizens that are willing to adopt high risk in exchange for not receiving any benefit. From 1946-1948, US scientists infected patients in Guatemala with STDS. Within the US, patients’ rights have been disrespected and exploited, for instance in the well-known and egregious case of the Tuskegee experiments, where a group of African American patients were denied treatment for their syphilis in order to see how the disease progressed over their lives.

There is, of course, value in pursuing scientific advancement through clinical trials. The results of such trials could help a number of people, increasing the quality of life for many. This benefit must be weighed against the possible exploitation of research subjects and accepting the risk that the experiment will result in harm to the subjects.

July 31, 2017December 14, 2022

Sacrifice in the Name of Sport

On July 25, The Journal of the American Medical Association published a study on the correlation between a distinctive brain damage (chronic traumatic encephalopathy, or CTE) and playing football professionally. The study included 202 brains of individuals who played football at some point in life, 111 of which were of former NFL players. They found that only one of the professional football players didn’t have CTE.

Continue reading “Sacrifice in the Name of Sport”

March 2, 2017December 14, 2022

On Providing Safe Spaces for Drug Use

Under new legislation in Maryland, spaces will be provided for illegal narcotics to be ingested in clean facilities under the supervision of medical professionals. There are nearly 100 such facilities worldwide, largely in Europe, where they have existed since the early 1980s. In the United States, where rates of accidental death from opioid overdose have “quadrupled since the late 1990s,” these facilities are still largely a controversial possibility.

Continue reading “On Providing Safe Spaces for Drug Use”

October 24, 2016December 14, 2022

Curing HIV in a Creationist America

With 36.7 million people worldwide living with HIV in 2015, and 2.1 million newly infected people last year, the search for a cure for human immunodeficiency virus and the syndrome that follows, AIDS, is dire. Traditionally, children who are born with HIV will die from AIDS before their second year if not treated. However, monkeys infected with the equivalent virus, SIV, will typically survive. To the scientific community’s surprise, scientists have found that a “monkey-like” gene found in some children may be a leap closer to a cure. This discussion of treatment for AIDS automatically assumes an evolutionist perspective on humans. Does finding the cure for HIV go against pivotal American values?

Continue reading “Curing HIV in a Creationist America”

October 2, 2016December 14, 2022

A Post-Antibiotic Era: Antibiotics and Food

Since the 1950s, the agricultural industry has used antibiotics as a precautionary measure to prevent widespread infection in the crowded, restrictive settings of a food animal farm. Antibiotics are readily available, low cost, and promote profitable weight gain in food animals compared to other capable forms. Approximately 80% of all antibiotics sold in the United States can be traced back to agricultural usage and many overlap with the antibiotics used to treat human illnesses. The World Health Organization classified several growth-promoting antibiotics utilized by food corporations as critically important to human medicine. The FDA does not strictly regulate the use of antibiotics for agricultural purposes.

Continue reading “A Post-Antibiotic Era: Antibiotics and Food”

August 9, 2016December 14, 2022

Modifying the Mosquito

Never in recent memory have the bounds of human impact on the world felt so wide. At a time when researchers are finding cans of soda at the bottom of the Marianas Trench, and scientists are grappling with the possibility of creating human-animal “chimera” tissues for study, our ability to influence the world around us seems practically unparalleled. And when it comes to dealing with a public health crisis brought on by one of nature’s most annoying pests, it would seem that these limits may soon expand once again.

Continue reading “Modifying the Mosquito”

May 9, 2016December 14, 2022

Outdoor Exercise Versus Air Pollution

A recent study by the University of Cambridge reported that the benefits of walking and cycling outside outweigh the risks associated with current air pollution levels in the UK . Approximately 40,000 deaths in the UK per year are attributed to exposure to outdoor air pollution, and outdoor exercise contributes to that exposure. However, according to the University of Cambridge researchers, the health benefits of exercise, namely lowering the risk of diabetes, heart disease, and several cancers, outweighs the harmful effects of air pollution to one’s body.

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